Extended-field chemoradiation therapy (EF-CRT) could be used as a potentially curative treatment option for patients with squamous cell carcinoma (SCC) of the anal canal with distant metastasis to the para-aortic (PA) lymph nodes. The finding comes from a retrospective review published in Clinical Investigation

Squamous cell carcinoma with distant PA metastasis is considered to be advanced disease. Typically metastatic SCC is not treated with curative intent. However in some cases where there is limited metastatic distant node involvement, a case has been made for curative treatment. The study authors of this review retrospectively assessed 30 patients with SCC of the anal canal metastatic to the PA lymph nodes at the time of diagnosis, who were treated in a curative attempt with extended-field chemoradiation therapy at 2 tertiary care centers between September 2002 and February 2016.

At a median follow-up period of 3.1 years, 18 patients were alive and 17 were without anal cancer following definite and salvage treatments. Disease-free survival at 3 years was 42%. Overall survival was 67%. Approximately 50% of patients experienced cancer recurrence at a median of 0.9 years mostly at distant metastatic sites. Approximately 30% of patients experienced a grade 3-4 gastrointestinal event, 27% a grade 3-4 dermatologic adverse event, and 20% a grade 3-4 hematologic adverse event. No grade 5 adverse events were detected. 

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Based on these findings, the study authors recommend “that all patients presenting with anal cancer and distant metastases isolated to the PA nodes undergo multidisciplinary evaluation to determine patient fitness and feasibility of administering EF-CRT.” 


Holliday EB, Lester SC, Harmsen WS, et al.Extended-field chemoradiation therapy for definitive treatment of anal canal squamous cell carcinoma involving the para-aortic lymph nodes.Int J Radiat Oncol Biol Phys.2018;102(1):102-108.